SummaryCultured fibroblasts from two sibs with generalized hypertonia, hepatosplenomegaly, and psychomotor retardation within the first year of life were found to have unusual morphologic features. When examined by phase microscopy, the unstained and unfixed cells contained a large number of vacuolated structures whose gross appearance resembled that of a honeycomb in the cell cytoplasm. Electron microscopy studies, following fixation, showed the "honeycombing" to be the result of numerous, closely packed, cytoplasmic, membrane-bound vacuoles. In some of these structures the remains of fibrillogranular material could be detected.Biochemical analysis of crude snnicates of these cells revealed increased levels (4-7 x N) of an acid soluble component that reacted with thiobarbituric acid. Analysis of trimethylsilyl derivatives of this material by gas liquid chromatography and mass spectrometry showed it to be indistinguishable from sialic acid (Nacetylneuraminic acid). Quantitation of this material from the cells of one of the sibs after isolation on a Dowex column yielded 39.8 nmoles of free (unbound) sialic acid per mg protein whereas normal fibroblasts had 1-2 nmoles per mg. Bound sialic acid levels were at the upper limits of normal (24.8 versus 11-23 nmoles per mg protein). The concentration of cytidine monophosphate-sialic acid was normal.After incubation of the patient's fibroblasts with [3H]-~-acetylmaunosamine for 72 h, there was a 7-fold increase (compared to normal fibroblasts) in the amount of radioactivity in free sialic acid present in the acid soluble fraction. The amount of labeled, bound sialic acid in the acid-insoluble pool, however, was the same in both patient and control fibroblasts. Over the past few years several clinical forms of sialidosis have been described (14). Common to each of these related disorders has been an increased accumulation and/or excretion of sialic acid (N-acetylneuraminic acid) covalently linked to a variety of oligosaccharides and/or glycoproteins. Additionally, it has been demonstrated that these alterations are associated with, and presumptively the result of, a deficiency of a lysosomal sialidase (neuraminidase) (4,20,22).We now describe the morphologic and biochemical features of fibroblasts cultured from two infants (sibs) who suffer not from a storage of "bound" sialic acid but, rather, from an increased accumulation and excretion of free sialic acid. In contrast to the sialidosis patients, these individuals have normal to above normal levels of sialidase. The clinical and/or biochemical findings in these patients clearly indicate that they suffer from a disorder distinct from either Salla disease (3, 17) or sialuria (15), both of which are also characterized by an increased accumulation and/ or excretion of unbound sialic acid. These sibs, however, do appear to have certain features in common with patients recently described by Hancock et al.
MATERIALS AND METHODSCultured fibroblasts were established from skin biopsies of the patients and controls as previously ...